4. diabetes - npaihb4.6 diabetes control and management: blood sugar control blood sugar control is...

4. Diabetes

pg 49: Section description

pg 50-51: Self-reported diabetes

pg 52-53: Diabetes prevalence

pg 54-55: Diabetes control and management: blood sugar control

pg 56-57: Diabetes control and management: blood pressure control

pg 58-63: Diabetes control and management: recommended screenings

pg 64-65: Diabetes hospitalizations

pg 66-67: Diabetes mortality

pg 68: Program spotlight: Western Tribal Diabetes Project (WTDP)

pg 220: Diabetes hospital discharge rates map (Appendix I)

pg 221: Diabetes mortality rates map (Appendix I)

Diabetes (also called diabetes mellitus) is

a chronic disease caused by high levels of

blood glucose (or blood sugar). Blood glucose

levels are controlled by the hormone insulin,

which moves glucose from the blood into cells

to be used as energy. In type 1 diabetes, the

body does not make enough insulin to control

blood sugar levels. In type 2 diabetes (the

most common type), the body no longer uses

insulin efficiently. Although the two forms are

different in many ways, the end result of both

is high blood sugar. If left untreated, diabetes

can damage nearly every tissue in the body,

and can cause heart attacks, stroke, blindness,

kidney failure, and amputations of toes, feet, or

legs because of non-healing infections.1

AI/AN adults have among the highest rates

of diabetes in the U.S. From 2010-2012, the

age-adjusted percentage of AI/AN adults with

diabetes was 15.9%, compared to 7.6% for

NHW, 12.8% for Hispanics, and 13.2% for

African Americans.2 AI/AN diabetes rates

vary by region, from 6% for Alaska Natives

to 24.1% for American Indians in Arizona.2

Diabetes is the fourth leading cause of death

for AI/AN nationwide.

While AI/AN in Oregon have higher rates

of diabetes than NHW in the state, the

prevalence of diabetes among IHS patients is

lower in Oregon compared to the national IHS

average. Diabetes is the fifth leading cause

of death for AI/AN in Oregon. The death rate

from diabetes is nearly three times higher for

AI/AN compared to NHW, and AI/AN men have

a higher risk of dying from diabetes than AI/AN

women.

While diabetes is a life-long disease, it can

be managed by exercising regularly, eating

a healthful diet, taking medications, and

getting regular health check-ups. People with

pre-diabetes can reduce their risk by getting

regular physical activity, losing a moderate

amount of weight, and eating a balanced diet.

Since 1997, the Special Diabetes Program

for Indians (SDPI) has funded initiatives

to prevent and treat diabetes in AI/AN

communities. These initiatives have resulted in

improved access to treatment and prevention

services and improved clinical outcomes for

diabetes patients.3

1. National Diabetes Information Clearinghouse. Your guide to diabetes: Type 1 and Type 2. Available at: http://www.diabetes.niddk.nih.gov/dm/pubs/type1and2/index.aspx.

2. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.

3. Indian Health Service Division of Diabetes Treatment and Prevention. Special Diabetes Program for Indians: Successful Interventions and Sustained Achievements (2012). Available at: http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=resourcesFactSheets#2

4. Diabetes

49Diabetes

50 Diabetes

Figure 4.1 shows the prevalence of self-reported diabetes among AI/AN and NHW adults in

Oregon. From 2006-2012, AI/AN males and females had the same rate of diabetes (7%). This was

higher than the rate among NHW males (5%) and females (6%). The rate of gestational diabetes

was higher for AI/AN females (4%) than NHW females (1%). The rate of pre-diabetes was the

same for AI/AN and NHW females, and slightly higher for AI/AN males compared to NHW males.

Data Source: CDC Behavioral Risk Factor Surveillance System (BRFSS), 2006-2012.

Data Notes: The BRFSS prevalence estimates (shown as a percentage) are weighted to make the survey responses representative of the Oregon population. The sample sizes presented below the figures are the unweighted number of people who answered this question for the indicated years.

Self-Reported Diabetes

51Diabetes

4. Diabetes

Figure 4.1: Self-reported diabetes by race and sex, Oregon, 2006-2012.

Sample sizes (n): AI/AN males=170; AI/AN females=221; NHW males=13,060; NHW females=19,475.

4.1 Self-Reported Diabetes

Figure 4.1 shows the prevalence of self-reported diabetes among AI/AN and NHW adults in Oregon. From 2006-2012, AI/AN males and females had similar rates of diabetes (7%). This was higher than the rate among NHW males (5%) and females (6%). The rate of gestational diabetes was the higher for AI/AN females (4%) than NHW females (1%). The rate of pre-diabetes was similar across race and sex.

Figure 4.1: Self-reported diabetes by race and sex, Oregon, 2006-2012.

† Sample sizes (n): AI/AN males=170; AI/AN females=221; NHW males=13,060; NHW females=19,475.

Data Source: CDC Behavioral Risk Factor Surveillance System (BRFSS), 2006-2012.

Data Notes: The BRFSS prevalence estimates (shown as a percentage) are weighted to make the survey responses representative of the Oregon population. The sample sizes presented below the figures are the unweighted number of people who answered this question for the indicated years.

7.2% 7.4%

4.9%6.1%

0.0%

4.4%

1.2%0.0%

0.5%

0.5%

0.8%

0%

2%

4%

6%

8%

10%

12%

14%

AI/AN Male AI/AN Female NHW Male NHW Female

Per

cent

age

of P

opul

atio

n Pre-Diabetes orBorderline Diabetes

Gestational Diabetes(Female Only)

Diabetes Prevalence

52 Diabetes

From 2009-2013, AI/AN patients who received care at Indian health facilities in Oregon had a lower

prevalence of diabetes compared to IHS patients nationwide, and similar prevalence to Portland

Area patients (Figure 4.2). The diabetes prevalence in the Oregon patient population followed the

Portland Area IHS trend, with approximately a 1% increase over the 5 years, while the prevalence

in the national IHS patient population saw a larger increase over the same time period.

Data Source: Portland Area Indian Health Service.

Data Notes: Data labels only shown for Oregon clinics. 2013 data not available for IHS All Areas. Oregon clinics include non-urban federal and tribal Indian health facilities in Oregon. Portland Area IHS clinics in-clude non-urban federal and tribal Indian health facilities in Idaho, Oregon, and Washington.

Diabetes Prevalence

53Diabetes

4. Diabetes

Figure 4.2: Diabetes prevalence among IHS patients, 2009-2013.

4.2 Diabetes prevalence in the Portland IHS patient population

From 2009-2013, AI/AN patients who received care at Indian health facilities in Oregon had a lower prevalence of diabetes compared to IHS patients nationwide, and similar prevalence to Portland Area patients (Figure 4.2). The diabetes prevalence in the Oregon patient population followed the Portland Area IHS trend, with approximately a 1% increase over the 5 years, while the prevalence in the national IHS patient population saw a larger increase over the same time period.

Figure 4.2: Diabetes prevalence among IHS patients, by area, 2009-2013.


Data Notes: Data labels only shown for Oregon clinics. 2013 data not available for IHS All Areas. Oregon clinics include non-urban federal and tribal Indian health facilities in Oregon. Portland Area IHS clinics include non-urban federal and tribal Indian health facilities in Idaho, Oregon, and Washington.

10.3%10.8% 11.2% 11.2% 11.3%

0%

2%

4%

6%

8%

10%

12%

14%

16%

2009 2010 2011 2012 2013

Per

cent

age

of P

atie

nts

Portland Area IHS IHS All Areas Oregon Clinics

54 Diabetes Control & Management

Blood sugar control, as measured by the Hemoglobin A1c, is an important indicator of how well

diabetes patients are managing their disease. The U.S. goal is for 58.9% of adults with diabetes to

have a hemoglobin A1c level below 7% (Healthy People 2020). Until 2012, IHS defined ideal blood

sugar control as having a hemoglobin A1c level below 7%. This treatment goal was relaxed in 2013

to a hemoglobin A1c result below 8%.

From 2009 to 2012, between 38-41% of AI/AN diabetes patients seen in Oregon clinics had ideal

blood sugar levels. In 2013, this increased to 55.1% as a result of the definition change. Over all

years, Oregon clinics have a higher percentage of patients with controlled blood sugar compared

to both the Portland Area IHS overall, national IHS average.


Data Notes: The shaded area shows the year when the definition for ideal blood control changed. Data labels only shown for Oregon clinics. Oregon clinics include non-urban federal and tribal Indian health facilities in Oregon. Portland Area IHS clinics include non-urban federal and tribal Indian health facilities in Idaho, Oregon, and Washington.

Diabetes Control and Management: Blood Sugar Control

55Diabetes Control & Management

4. Diabetes

Figure 4.3: Percentage of IHS diabetes patients with ideal blood sugar control, 2009-2013.

4.6 Diabetes control and management: Blood sugar control

Blood sugar control is one measure of how well diabetes patients are managing their disease, and is typically indicated by a patient’s hemovglobin A1c level. Up until 2012, the IHS defined ideal blood sugar control as having a hemoglobin A1c level below 7%. This definition changed in 2013 to a hemoglobin A1C result below 8%. From 2009 to 2012, between 38-41% of AI/AN diabetes patients seen in Oregon clinics had ideal blood sugar levels. In 2013, this increased to 55.1% as a result of the definition change. Over all years, Oregon clinics have a higher percentage of patients with controlled blood sugar compared to both the Portland Area IHS overall, national IHS average.

Figure 4.3: Percentage of IHS diabetes patients with ideal blood sugar control by area, 2009-2013.


Data Notes: Data labels only shown for Oregon clinics. 2013 data not available for IHS All Areas. Oregon clinics include non-urban federal and tribal Indian health facilities in Oregon. Portland Area IHS clinics include non-urban federal and tribal Indian health facilities in Idaho, Oregon, and Washington.

41.0% 38.3%37.8%

38.7%

55.1%

0%

10%

20%

30%

40%

50%

60%

2009 2010 2011 2012 2013

Per

cent

age

of P

atie

nts

with

Dia

bete

s


Prior to 2013, ideal blood sugar was defined as hemoglobin A1c < 7%. Starting in 2013, ideal blood sugar is defined as hemoglobin A1c < 8%.


Diabetes patients have increased risks for heart disease, and can reduce these risks by managing

their blood pressure. The U.S. goal is for 57% of adults with diabetes to have their blood pressure

under control (Healthy People 2020). Until 2012, IHS defined ideal blood pressure control for

diabetes patients as having a blood pressure level below 130/80 mm Hg. This treatment goal was

relaxed in 2013 to a blood pressure level below 140/90 mm Hg.

From 2009 to 2012, approximately between 34-38% of AI/AN diabetes patients seen in Oregon

clinics had ideal blood pressure levels. In 2013, this increased to 55.8% as a result of the definition

change. Oregon clinics have a lower percentage of patients with controlled blood sugar compared

to all IHS areas, but are approximately equal to the Portland Area IHS average.



Blood Pressure Control


4. Diabetes

Figure 4.4: Percentage of IHS diabetes patients with ideal blood pressure, 2009-2013.

4.7 Diabetes control and management: Blood pressure control

Diabetes patients have increased risks for heart disease, and can reduce these risks by managing their blood pressure. Up until 2012, the IHS defined ideal blood pressure control for diabetes patients as having a blood pressure level below 130/80 mm Hg. This definition changed in 2013 to a blood pressure level below 140/90 mm Hg. From 2009 to 2012, approximately between 34-38% of AI/AN diabetes patients seen in Oregon clinics had ideal blood pressure levels. In 2013, this increased to 55.8% as a result of the definition change. Oregon clinics have a lower percentage of patients with controlled blood sugar compared to all IHS areas, but are approximately equal to the Portland Area IHS average.

Figure 4.4: Percentage of IHS diabetes patients with ideal blood pressure by area, 2009-2013.



37.7% 36.9%32.4%

34.8%

65.8%

0%

10%

20%

30%

40%

50%

60%

70%

2009 2010 2011 2012 2013

Per

cent

age

of P

atie

nts

with

Dia

bete

s


Prior to 2013, ideal blood pressure was defined as <130/80 mm/Hg. Starting in 2013, ideal blood pressure is defined as <140/90 mm/Hg.


Diabetes patients are at increased risk for heart disease, kidney disease, eye problems, and other

health issues. Diabetes patients can reduce their risk for these complications by receiving regular

screening and monitoring. Routine physical examinations and test can help patients and their

healthcare providers to manage diabetes and related health issues. IHS has performance goals

to measure how many diabetes patients are examined yearly for LDL (low density lipoprotein)

cholesterol (related to heart disease risk), nephropathy (related to kidney disease risk), and

diabetic retinopathy (or diabetic eye disease).

LDL Cholesterol Assessment: From 2009-2012, approximately 73% of AI/AN diabetes patients

seen in Oregon clinics had their LDL cholesterol levels assessed. This increased to 74.5% in 2013,

which exceeded the IHS goal of 68% (Figure 4.5). Since 2009, Oregon clinics have matched or

performed better than both Portland Area and national IHS patients. The national IHS average has

increased since 2009, and also exceeded the 2013 goal.


Data Notes: Data labels only shown for Oregon clinics. Oregon clinics include non-urban federal and tribal Indian health facilities in Oregon. Portland Area IHS clinics include non-urban federal and tribal Indian health facilities in Idaho, Oregon, and Washington.

Screening - LDL Cholesterol Assessment


4. Diabetes

Figure 4.5: Percentage of IHS diabetes patients who received an LDL assessment, 2009-2013.

4.8 Diabetes control and management: Recommended screenings – LDL Assessment

Diabetes patients are at increased risk for heart disease, kidney disease, eye problems, and other health issues. Diabetes patients can reduce their risk for these complications by receiving regular exams. These exams can help patients and their healthcare providers to manage diabetes and other related health issues. The IHS has performance goals to measure how many diabetes patients receive yearly exams for LDL (low density lipoprotein) cholesterol (related to heart disease risk), nephropathy (related to kidney disease risk), and diabetic retinopathy (or diabetic eye disease).

LDL Cholesterol Assessment: From 2009-2012, approximately 73% of AI/AN diabetes patients seen in Oregon clinics had their LDL cholesterol levels assessed. This increased to 74.5% in 2013, which exceeded the IHS goal of 68% (Figure 4.5). Since 2009, Oregon clinics have matched or performed better than both Portland Area and national IHS patients. The national IHS average has increased since 2009, and also exceeded the 2013 goal.

Figure 4.5: Percentage of IHS diabetes patients who received an LDL assessment by area, 2009-2013.



73.0% 72.2% 72.2% 72.5% 74.5%

IHS 2013 Goal: 68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009 2010 2011 2012 2013

Per

cent

age

of P

atie

nts

with

Dia

bete

s

Portland Area IHS IHS All Areas Oregon Clinics IHS 2013 Goal


Diabetic Nephropathy: The percentage of Oregon AI/AN diabetes patients who had a diabetic

nephropathy assessment has increased from 42.1% in 2009 to 68% in 2013, exceeding the IHS

2013 goal of 64.2%. Until 2013, Oregon clinics have had a lower percentage of patients who

received this recommended screening compared to both the Portland Area IHS and national IHS.

By 2013, Oregon clinics are performing on par with both Portland Area and national IHS, all of

which are exceeding the national goal.



Screening - Nephropathy Assessment


4. Diabetes

Figure 4.6: Percentage of IHS diabetes patients who received a nephropathy assessment, 2009-2013.

4.9 Diabetes control and management: Recommended screenings – Nephropathy Assessment

Diabetic Nephropathy: The percentage of Oregon AI/AN diabetes patients who had a diabetic nephropathy assessment has increased from 42.1% in 2009 to 68% in 2013, exceeding the IHS 2013 Goal of 64.2%. Until 2013, Oregon clinics have had a lower percentage of patients who received this recommended screening compared to both the Portland Area IHS and national IHS. By 2013, Oregon clinics are performing on par with both Portland Area and national IHS, all of which are exceeding the national goal.

Figure 4.6: Percentage of IHS diabetes patients who received a nephropathy assessment by area, 2009-2013.



42.1%45.6%

52.9%

59.2%

68.0%

IHS 2013 Goal: 64.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2009 2010 2011 2012 2013

Per

cent

age

of P

atie

nts

with

Dia

bete

s



Diabetic Retinopathy: The U.S goal is for 58.7% of adults with diabetes to have had a dilated eye

exam in the past year, (Healthy People 2020), and the IHS goal for 2013 was for 56.8% to have

received this recommended screening.

The percentage of Oregon AI/AN diabetes patients who had a diabetic retinopathy exam has

increased from 53.7% in 2009 to 61.5% in 2013. Since 2009, Oregon clinics have had a higher

percentage of patients who received this recommended screening compared to the Portland Area

IHS (Figure 4.7). In 2013, Oregon clinics exceeded the IHS 2013 Goal of 56.8%. The national IHS

average has increased over time and met the 2013 goal for this measure.



Screening - Retinopathy Assessment


4. Diabetes

Figure 4.7: Percentage of IHS diabetes patients who received a retinopathy assessment, 2009-2013.

4.10 Diabetes control and management: Recommended screenings – Retinopathy Assessment

Diabetic Retinopathy: The percentage of Oregon AI/AN diabetes patients who had a diabetic retinopathy exam has increased from 53.7% in 2009 to 61.5% in 2013. Since 2009, Oregon clinics have had a higher percentage of patients who received this recommended screening compared to the Portland Area IHS (Figure 4.7). In 2013, Oregon clinics exceeded the IHS 2013 Goal of 56.8%. The national IHS average has increased over time and met the 2013 goal for this measure.

Figure 4.7: Percentage of IHS diabetes patients who received a retinopathy assessment by area, 2009-2013.



53.7%50.2%

55.5% 53.1%

61.5%

IHS 2013 Goal: 56.8%

0%

10%

20%

30%

40%

50%

60%

70%

2009 2010 2011 2012 2013

Per

cent

age

of P

atie

nts

with

Dia

bete

s


64 Diabetes

From 2010 to 2011, 1.8% of AI/AN inpatient hospitalizations in Oregon had a primary diagnosis of

diabetes (with or without complications); this percentage is almost two times greater than for NHW

(1.0%) (Table 4.1). Males had a higher percentage than females for both race groups, with AI/AN

males having the highest percentage of hospitalizations for diabetes (2.6%). The age-adjusted

hospital discharge rate for diabetes mellitus was higher for AI/AN than NHW regardless of sex, with

the widest gap seen among females – the rate for AI/AN females was nearly twice that of NHW

females.

Data Source: Oregon inpatient hospital discharge data (2010-2011), corrected for misclassified AI/AN race, IDEA-NW Project, NPAIHB.

Data Notes: Data are from the Oregon Office for Health Policy and Research; race-corrected and com-piled by the IDEA-NW Project, NPAIHB. AI/AN includes any mention of AI/AN in either the OR state hospital discharge data or the Northwest Tribal Registry (NTR), which is maintained by the IDEA-NW Project at NPAIHB.

Diabetes Hospitalizations

65Diabetes

4. Diabetes

Table 4.1: Inpatient hospital discharges for diabetes by race and sex, Oregon, 2010-2011.

Figure 4.8: Age-adjusted hospital discharge rates for diabetes by race and sex, Oregon, 2010-2011.

† N = number of hospitalizations. The percentages were calculated using the total inpatient hospitalizations for each group: AI/AN male (N=4,603), AI/AN female (N=7,015), AI/AN total (N=11,618), NHW male (N=225,270), NHW female (N=303,952), and NHW total (N=529,222).

4.3 Diabetes hospitalizations

From 2010 to 2011, 1.8% of AI/AN inpatient hospitalizations in Oregon had a primary diagnosis of diabetes mellitus (with or without complications); this percentage is almost two times greater than for non-Hispanic whites (NHW) alone (1.0%) (Table 4.1). Males had a higher percentage than females for both race groups, with AI/AN males having the highest percentage of hospitalizations for diabetes (2.6%). The age-adjusted hospital discharge rate for diabetes mellitus was higher for AI/AN than NHW regardless of sex, with the widest gap seen among females – the rate for AI/AN females was nearly twice that of NHW females.

Table 4.1: Inpatient hospital discharges for diabetes mellitus by race and sex, Oregon, 2010-2011.

Sex AI/ANN† (%)

NHWN† (%)

Male 120 (2.6%) 2,830 (1.3%)Female 85 (1.2%) 2,393 (0.8%)

Both Sexes 205 (1.8%) 5,223 (1.0%)

N† = number of hospitalizations. The percentages were calculated using the total inpatient hospitalizations for each group: AI/AN male (n=4,603), AI/AN female (n=7,015), AI/AN total (n=11,618), NHW male (n=225,270), NHW female (n=303,952), and NHW total (n=529,222).



Data Notes: Data are from the Oregon Office for Health Policy and Research; race-corrected and compiled by the IDEA-NW Project, NPAIHB. AI/AN includes any mention of AI/AN in either the OR state hospital discharge data or the Northwest Tribal Registry (NTR), which is maintained by the IDEA-NW Project at NPAIHB.

106.2

102.9

110.1

187.7

193.9

180.2

0 50 100 150 200 250

Both Sexes

Female

Male

Age-Adjusted Rate per 100,000

AI/AN

NHW

4.3 Diabetes hospitalizations

From 2010 to 2011, 1.8% of AI/AN inpatient hospitalizations in Oregon had a primary diagnosis of diabetes mellitus (with or without complications); this percentage is almost two times greater than for non-Hispanic whites (NHW) alone (1.0%) (Table 4.1). Males had a higher percentage than females for both race groups, with AI/AN males having the highest percentage of hospitalizations for diabetes (2.6%). The age-adjusted hospital discharge rate for diabetes mellitus was higher for AI/AN than NHW regardless of sex, with the widest gap seen among females – the rate for AI/AN females was nearly twice that of NHW females.

Table 4.1: Inpatient hospital discharges for diabetes mellitus by race and sex, Oregon, 2010-2011.

Sex AI/ANN† (%)

NHWN† (%)

Male 120 (2.6%) 2,830 (1.3%)Female 85 (1.2%) 2,393 (0.8%)

Both Sexes 205 (1.8%) 5,223 (1.0%)

N† = number of hospitalizations. The percentages were calculated using the total inpatient hospitalizations for each group: AI/AN male (n=4,603), AI/AN female (n=7,015), AI/AN total (n=11,618), NHW male (n=225,270), NHW female (n=303,952), and NHW total (n=529,222).



Data Notes: Data are from the Oregon Office for Health Policy and Research; race-corrected and compiled by the IDEA-NW Project, NPAIHB. AI/AN includes any mention of AI/AN in either the OR state hospital discharge data or the Northwest Tribal Registry (NTR), which is maintained by the IDEA-NW Project at NPAIHB.

106.2

102.9

110.1

187.7

193.9

180.2

0 50 100 150 200 250

Both Sexes

Female

Male

Age-Adjusted Rate per 100,000

AI/AN

NHW

66 Diabetes

From 2006-2010, diabetes was the fifth leading cause of death among AI/AN in Oregon. Figure

4.9 shows the age-adjusted death rates for diabetes among AI/AN and NHW in Oregon. AI/AN

males were 23% more likely to die from the disease than AI/AN females. Compared to NHW,

AI/AN diabetes death rates were 2.8 times higher (Figure 4.9). Throughout the Northwest, AI/AN in

all three states had very similar diabetes death rates.

Data Source: Oregon state death certificates, 2006-2010, corrected for misclassified AI/AN by the IDEA-NW Project.

Diabetes Mortality

67Diabetes

4. Diabetes

Table 4.2: Age-adjusted diabetes mortality rates by race and sex, Oregon, 2006-2010.

Figure 4.9: Age-adjusted diabetes mortality rates by race and sex, Oregon, 2006-2010.

4.4 Diabetes mortality

From 2006-2010, diabetes was the fifth leading cause of death among AI/AN in Oregon. Figure 4.9 shows the age-adjusted mortality rates for diabetes among AI/AN and NHW in Oregon. AI/AN males were more likely to die from diabetes than AI/AN females. Diabetes mortality rates for AI/AN were over two times higher compared to NHW (Figure 4.9). AI/AN in the states of Idaho, Oregon, and Washington have very similar diabetes mortality rates.

Table 4.9: Diabetes mortality rates by race and sex, Oregon, 2006-2010.

SexAI/AN Rate

(95% CI)NHW Rate(95% CI)

AI/AN vs. NHW Rate Ratio(95% CI)

Male 75.7 (55.0, 103.2) 29.3 (28.0, 30.6) 2.6 (2.0, 3.3)†

Female 61.5 (45.8, 81.3) 20.3 (19.0, 21.5) 3.0 (2.4, 3.9)†

Both Sexes 67.5 (55.8, 82.6) 24.3 (23.4, 25.2) 2.8 (2.3, 3.3)†

CI = confidence interval† Indicates a statistically significant difference (p<.05)



Data Notes: ICD classification follows WISQARS; excludes deaths of infants under one year old.

75.7

61.567.5

29.3

20.324.3

0

20

40

60

80

100

120

Male Female Both sexes

Age

-Adj

uste

d M

orta

lity

Rat

e pe

r 100

,000

AI/AN NHW

4.4 Diabetes mortality

From 2006-2010, diabetes was the fifth leading cause of death among AI/AN in Oregon. Figure 4.9 shows the age-adjusted mortality rates for diabetes among AI/AN and NHW in Oregon. AI/AN males were more likely to die from diabetes than AI/AN females. Diabetes mortality rates for AI/AN were over two times higher compared to NHW (Figure 4.9). AI/AN in the states of Idaho, Oregon, and Washington have very similar diabetes mortality rates.

Table 4.9: Diabetes mortality rates by race and sex, Oregon, 2006-2010.

SexAI/AN Rate

(95% CI)NHW Rate(95% CI)

AI/AN vs. NHW Rate Ratio(95% CI)

Male 75.7 (55.0, 103.2) 29.3 (28.0, 30.6) 2.6 (2.0, 3.3)†

Female 61.5 (45.8, 81.3) 20.3 (19.0, 21.5) 3.0 (2.4, 3.9)†

Both Sexes 67.5 (55.8, 82.6) 24.3 (23.4, 25.2) 2.8 (2.3, 3.3)†

CI = confidence interval† Indicates a statistically significant difference (p<.05)



Data Notes: ICD classification follows WISQARS; excludes deaths of infants under one year old.

75.7

61.567.5

29.3

20.324.3

0

20

40

60

80

100

120

Male Female Both sexes

Age

-Adj

uste

d M

orta

lity

Rat

e pe

r 100

,000

AI/AN NHW

68 Diabetes

Program Spotlight: Western Tribal Diabetes ProjectThe WTDP assists tribal programs in tracking, reporting, and utilizing accurate data on patients with diabetes. This information is used to improve the quality of patient care, gain additional resources, and plan effective intervention programs to reduce the burden of diabetes at the local level. WTDP provides tribes with training, technical assistance, and tools so they can:

• Build a foundation to provide complete and accurate information about patients with diabetes

• Estimate the burden of disease and impact of diabetes by using an electronic diabetes register

• Improve health outcomes by using an electronic diabetes register to make informed decisions about clinical diabetes care

• Prevent diabetes in high-risk individuals.

WTDP holds regular trainings on the Diabetes Management System, provides technical assistance with completing the Annual IHS Diabetes Audit and maintaining local diabetes registers, prepares tribe and area-level reports on patient care and outcomes, and provides information on best practices to prevent and manage diabetes. WTDP also partners with the Portland Area IHS and Nike to host Nike Native Fitness workshops at the Nike World Headquarters in Beaverton, OR. WTDP is funded by an annual 5% set-aside from the Portland Area’s allocation for the Special Diabetes Program for Indians.

For more information, please contact:

Kerri Lopez (Tolowa Tribe)

Project Director

[email protected]

503-416-3301

http://www.npaihb.org/epicenter/project/wtdp

mailto:[email protected]

http://www.npaihb.org/epicenter/project/wtdp

4. diabetes - npaihb4.6 diabetes control and management: blood sugar control blood sugar control is...

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